Aversive Therapy for Drinking

Aversive Therapy for Drinking

Aversive Therapy for Drinking

Another excellent example of aversion therapy was pioneered by Roger Vogler and his associates (1977). Vogler worked with alcoholics who were unable to stop drinking and for whom aversion therapy was a last chance. While drinking an alcoholic beverage, clients receive a painful (although not injurious) electric shock to the hand. Most of the time, these shocks occur as the client is beginning to take a drink of alcohol.

These response-contingent shocks (shocks that are linked to a response) obviously take the pleasure out of drinking. Shocks also cause the alcohol abuser to develop a conditioned aversion to drinking. Normally, the misery caused by alcohol abuse comes long after the act of drinking—too late to have much effect. But if alcohol can be linked with immediate discomfort, then drinking will begin to make the individual very uncomfortable.

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization. Chapter 15522

Is it really acceptable to treat clients this way? People are often disturbed (shocked?) by such methods. However, clients usually volunteer for aversion therapy because it helps them overcome a destructive habit. Indeed, commercial aversion programs for over- eating, smoking, and alcohol abuse have attracted many willing customers. More important, aversion therapy can be justified by its long-term benefits. As behaviorist Donald Baer put it, “A small number of brief, painful experiences are a reasonable exchange for the interminable pain of a lifelong maladjustment.”

Desensitization

How is behavior therapy used to treat phobias, fears, and anxieties? Suppose you want to help Curtis overcome fear of the high diving board. How might you proceed? Directly forcing Curtis off the high board could be a psychological disaster. A better approach would be to begin by teaching him to dive off the edge of the pool. Then he could be taught to dive off the low board, followed by a platform 6 feet above the water and then an 8-foot platform. As a last step, Curtis could try the high board.

Who’s Afraid of a Hierarchy? This rank-ordered series of steps (called a hierarchy) allows Curtis to undergo adaptation. Gradually, he adapts to the high dive and overcomes his fear. When Curtis has conquered his fear, we can say that desensitization (dee-SEN-sih-tih-ZAY-shun) has occurred (Spiegler & Guevremont, 2010).

Desensitization is also based on reciprocal inhibition (using one emotional state to block another) (Heriot & Pritchard, 2004).

For instance, it is impossible to be anxious and relaxed at the same time. If we can get Curtis onto the high board in a relaxed state, his anxiety and fear will be inhibited. Repeated visits to the high board should cause fear to disappear in this situation. Again, we would say that Curtis has been desensitized. Typically, systematic desensitization (a guided reduction in fear, anxiety, or aversion) is attained by gradually approaching a feared stimulus while maintaining relaxation.

What is desensitization used for? Desensitization is used primarily to help people unlearn phobias (intense, unrealistic fears) or strong anxieties. For example, each of these people might be a candidate for desensitization: a teacher with stage fright; a student with test anxiety; a salesperson who fears people; or a newlywed with an aversion to sexual intimacy.

Aversive Therapy for Drinking

Feeling a Little Tense? Relax!  Discovering Psychology

The key to desensitization is relaxation. To inhibit fear, you must learn to relax. One way to voluntarily relax is by using the tension-release method. To achieve deep muscle relaxation, try the following exercise:

Tense the muscles in your right arm until they tremble. Hold them tight as you slowly count to ten and then let go. Allow your hand and arm to go limp and to relax completely. Repeat the procedure. Releasing tension two or three times will allow you to feel whether your arm muscles have relaxed. Repeat the tension– release procedure with your left arm. Compare it with your right arm. Repeat until the left arm is equally relaxed. Apply the tension–release technique to your right leg; to your left leg; to your abdomen; to your chest and shoulders. Clench and release your chin, neck, and throat. Wrinkle and release your forehead and scalp. Tighten and release your mouth and face muscles. As a last step, curl your toes and tense your feet. Then release. Aversive Therapy for Drinking.

If you carried out these instructions, you should be noticeably more relaxed than you were before you began. Practice the tension- release method until you can achieve complete relaxation quickly (5 to 10 minutes). After you have practiced relaxation once a day for a week or two, you will begin to be able to tell when your body (or a group of muscles) is tense. Also, you will begin to be able to relax on command. This is a valuable skill that you can apply in any situation that makes you feel tense or anxious.

Programs for treating fears of flying combine relaxation, systematic desensitization, group support, and lots of direct and indirect exposure to airliners. Many such programs conclude with a brief flight, so that participants can “test their wings.” Aversive Therapy for Drinking.

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.

Therapies 523

Hierarchy A rank-ordered series of higher and lower amounts, levels, degrees, or steps.

Reciprocal inhibition The presence of one emotional state can inhibit the occurrence of another, such as joy preventing fear or anxiety inhibiting pleasure.

Systematic desensitization A reduction in fear, anxiety, or aversion brought about by planned exposure to aversive stimuli.

Tension-release method

A procedure for systematically achieving deep relaxation of the body.

Vicarious desensitization

A reduction in fear or anxiety that takes place vicariously (“secondhand”) when a client watches models perform the feared behavior.

Virtual reality exposure

Use of computer-generated images to present fear stimuli. The virtual environment responds to a viewer’s head movements and other inputs.

Eye movement desensitization and reprocessing (EMDR)

A technique for reducing fear or anxiety; based on holding upsetting thoughts in mind while rapidly moving the eyes from side to side.

Performing Desensitization

How is desensitization done? First, the client and the therapist construct a hierarchy. This is a list of fear- provoking situations, arranged from least disturbing to most frightening. Second, the client is taught exercises that produce deep relaxation (see “Feeling a Little Tense? Relax!”). Third, once the client is relaxed, she or he tries to perform the least disturbing item on the list. For a fear of heights (acrophobia), this might be: “(1) Stand on a chair.” The first item is repeated until no anxiety is felt. Any change from complete relaxation is a signal that clients must relax again before continuing. Slowly, clients move up the hierarchy: “(2) Climb to the top of a small stepladder”; “(3) Look down a flight of stairs”; and so on, until the last item is performed without fear: “(20) Fly in an airplane.”

For many phobias, desensitization works best when people are directly exposed to the stimuli and situations they fear (Bourne, 2010; Miltenberger, 2011). For something like a simple spider phobia, this expo- sure can even be done in groups. Also, for some fears (such as fear of riding an elevator, or fear of spiders) desensitization may be completed in a single session (Müller et al., 2011; Sturges & Sturges, 1998). Aversive Therapy for Drinking.

Vicarious Desensitization What if it’s not practical to directly act out the steps of a hierarchy? For a fear of heights, the steps of the hierarchy might be acted out. However, if this is impractical, as it might be in the case of a fear of flying, the problem can be handled by having clients observe models who are performing the feared behavior (Eifert & Lejuez, 2000; Bourne, 2010; • Figure 15.2). A model is a person (either live or filmed) who serves as an example for observational learning. If such vicarious desensitization (secondhand learning) can’t be used, there is yet another option. Fortunately, desensitization works almost as well when a person vividly imagines each step in the hierarchy (Yahnke, Sheikh, & Beckman, 2003). If the steps can be visualized without anxiety, fear in the actual situation is reduced. Because imagining feared stimuli can be done at a therapist’s office, it is the most common way of doing desensitization.

Virtual Reality Exposure Desensitization is an exposure therapy. Similar to other such therapies, it involves exposing people to feared stimuli until their fears extinguish. In an important recent development, psychologists are now also using virtual reality to treat phobias. Virtual reality is a computer-generated, three-dimensional “world” that viewers enter by wearing a head-mounted video display. Virtual reality expo- sure presents computerized fear stimuli to clients in a realistic, yet carefully controlled fashion (Wiederhold & Wiederhold, 2005; Riva, 2009). It has already been used to treat fears of flying, driv- ing, and public speaking as well as acrophobia (fear of heights),

claustrophobia, and spider phobias (Arbona et al., 2004; Giuseppe, 2005; Lee et al., 2002; Meyerbröker & Emmelkamp, 2010; Müller et al., 2011; see • Figure 15.3.). Virtual reality exposure has also been used to create immersive distracting environments for help patients reduce the experience of pain (Malloy & Milling, 2010).

Desensitization has been one of the most successful behavior therapies. A relatively new technique may provide yet another way to lower fears, anxieties, and psychological pain.

Eye Movement Desensitization Traumatic events produce painful memories. Disturbing flash- backs often haunt victims of accidents, disasters, molestations, muggings, rapes, or emotional abuse. To help ease traumatic memories and post-traumatic stress, Dr. Francine Shapiro developed eye movement desensitization and reprocessing (EMDR).

• Figure 15.2 Treatment of a snake phobia by vicarious desensitization. These classic photo- graphs show models interacting with snakes. To overcome their own fears, phobic subjects observed the models (Bandura, Blanchard, & Ritter, 1969).

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.